I am currently working on an inpatients ward where I was the only one available to unwittingly take an unexpected phone call. The call came from a patient who was 11 weeks post surgery, had had her hip replaced and been treated for this, however had contracted several systemic infections that impaired her ability to exercise, socialize due to photophobia and left her feeling helpless. She was seriously confused as to what was and was not appropriate exercise and movements for her to be doing at this stage of 11 weeks post THR. The phone call lasted 45minutes, the first half of which I thought I was enduring a very chatty and cautious patient. When the tears came, I knew something seriously different was going on. Then came the full story. She is seriously depressed, isolated by her family and friends, dependent, insecure and anxious to the point of avoiding all physical activity. Panic attacks prevent her from making basic phone calls for help from medical practitioners and it seems she is not proactive as necessary to become fully recovered. Being immobile for 4 weeks in a dark room does not help her situation either!
I was really caught off-guard by this phone call, and felt for the poor lady who had obviously had a hard time with her supposed rehabilitation whilst being in and out of hospitals with other problems. Then I got bothered by something that kept recurring throughout the conversation. Something that could have been within our power as physiotherapists to help was quite pivotal to improving her attitude - communication. The pamphlets given to patients after and before surgery were not clear for her as to when to progress the exercises, when particular movements were permitted, etc. She was so confused that she avoided things like bending down to pick things up off the floor, sweeping the ground and had trouble looking after her cats because she was so afraid of doing the wrong thing.
I don't know if this is the case with her, but we as physiotherapists can be very good at emphasising the "don'ts" that patients don't know what they can do. They also need thorough explanation of the progression of their rehabilitation because it is not always logical for them. We have restricted time when working on the wards, but her confusion and fear avoidance behaviour could have been significantly improved by just taking a little extra time with someone who obviously is not physically aware of fitness and exercise. It's our responsibility, not another medical team member. I just never realised how some people can have absolutely no idea about exercise and activity - we sometimes REALLY have to spell it out, and that's important!
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2 comments:
Well done. That must have been very tough. For the lady to open up to you, it means you must have created a safe environment for her. That is a skill that many takes years and years to develop. It sounds that by just listening to the lady and giving her time she began to feel secure. Even though we need to be efficient with our time there are times like these that we need to give a little more. Definately thought provoking.
It sounds like you handled the situation really well v! Apart from the client interview we did in 2nd year, we havent really been exposed to alot of 'emotional' patients as a huge focus is on theory and practical Rx's. Hopefully most of us have an inbuilt empathetic ability, and maybe because we take an interest in pt's and come across as very caring, pt's feel as though they can let their fears/worries out.
I came across a very obese patient who had multiple areas of pain and was also very self conscious about her size. I was doing an Ax on her Lower back and she was telling me about the reason she had put on wt. Both her son and grandson had died in the last 10 years and understandably the tradegy had its toll on her and her family. As well as this, this pt was working as a volunteer social worker with families of victims of violence and drug abuse and trying to find save situations for them.
she also felt very embarrassed about not being able to afford proper underwear (as i had folder her pants slightly down to expose her lower back)
whilst telling me this, she started crying and said she had always been 'the strong one' who other people came to for strength. i spent the next 20 mins listening and ensuring her that the underwear factor was not an issue at all (as this had been the issue to top thigs off and cause tears) and let her talk about the things going on in her life.
As part of her Rx, i underwent a hydro session with her and emphasised that the time in the pool was "her time" to unwind and focus on her own issues. She visibly relaxed and the next day called the hospital specifically to thank me for listening.
Even though i didnt feel i had the skills to offer advice, i think that just listening and letting her know that I cared about helping her to lose wt really made a difference.
i agree with you v that listening and not handballing someone off can have a huge positive impact on their life.
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